- Email: [email protected]
Origins of cancer: from the cervix to the fallopian tube
S2
Pathology (2014), 46(S2)
PATHOLOGY 2014 ABSTRACT SUPPLEMENT
Since Siegfried Oberndorfer used the term carcinoid in 1907, this type of tumor has disclosed hormonally-active function and early metastases to the liver and lymph nodes. Neuroendocrine tumors (NETs) are now better accepted to represent the tumors. Thus, the WHO classification in 2000 first used the term endocrine tumors (ETs) instead of carcinoid, and NETs have been accepted as more popular terminology, i.e., well differentiated NET, well differentiated NEC (carcinoma) and poorly differentiated NEC. In the 2010 WHO classification of the digestive tract, NETs were re-classified to NET Grade (G)1, NET G2 and NEC, according to mitotic counts or Ki-67 labeling index. Neuroendocrine carcinoma, Ki-67 index higher than 20%, is composed of small and large cell types. Genetic background has been pointed out in pancreatic NETs such as mutations of MEN1, VHL and NF1 with specific biologic features. For therapeutic aspect, the expression of somatostatin receptor (SSTR2) is frequent (approximately 60%) in gastroenteric-pancreatic (GEP) NET and NEC, suggesting the response to somatostatin analogues, an example of molecular targeted therapy. Among NEC, a recently proposed category of NET G3 with typical neuroendocrine histological pattern and higher SSTR2 expression will be discussed. This lecture will highlight the important role of pathologists in diagnosis and therapy for NET and NEC.
Key Note Lecture: KN05 THE UPDATED GLEASON GRADING SYSTEM: MAKING IT RELEVANT TO CONTEMPORARY PRACTICE Jonathan I. Epstein Department of Pathology, The Johns Hopkins Medical Institutions, USA The talk will briefly cover why there was a need for modifying the original Gleason grading system. Multiple images will be presented covering the variations of different Gleason grade patterns and certain pitfalls in grading. Grading of variants of prostate cancer, such as foamy gland cancer, pseudohyperplastic cancer, ductal adenocarcinoma, cancer with vacuoles, mucinous carcinomas, and small cell carcinoma will be presented. The grading of cancer with mucinous fibroplasia as Gleason pattern 3 in most cases and cancer with glomeruloid features as Gleason pattern 4 will be discussed. Issues relating to grading needle biopsy when there is either a lower grade or higher present to a limited extent will be covered, as will the topic of tertiary grade patterns on needle biopsy and radical prostatectomy. Finally, the presentation will end with a brief review of prognostic information relating to the different Gleason grade patterns including a new Prognostic Grade Grouping.
internationally prominent clinicians held wide-ranging discussions concentrating on areas where new validated data exists that would impact on the classification or on the characterization and criteria for specific entities. Although publication of the update is not expected until Fall, 2015, areas in need of updating are established. On the B-cell side, there is great interest in dealing with the borders of lymphoma and clonal proliferations that are not overtly malignant as well as in learning how to best deal with the extra-aggressive B-cell lymphomas. New molecular discoveries have also had a major impact such as BRAF V600E mutations in hairy cell leukemia and MYD88 L265P mutation in lymphoplasmacytic lymphomas. We are also learning more about the complexity of the mature T-cell lymphomas and how to deal with the spectrum of T-cell lymphomas derived from T follicular helper cells and gamma delta type T-cells. Indolent clonal T- and NK-cell proliferations, such as those in the GI tract, have also received increased attention.
Keynote Lecture: KN07 ORIGINS OF CANCER: FROM THE CERVIX TO THE FALLOPIAN TUBE Christopher P. Crum Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA Success in cancer prevention depends on our understanding of its origins. In the past several years, we have gained insights into the pathogenesis of both cervical and ovarian cancer. We have identified a unique cell at the cervical squamo-columnar junction that has been proposed as a potential origin for most cervical cancers. This new information has put cervical precursors into perspective and explained the diversity of phenotypes associated with high-risk HPV infections. Moreover, it has raised the intriguing possibility that the squamo-columnar junction could be targeted in a cervical cancer prevention strategy for women who would not gain the maximum benefit from vaccination. In the upper genital tract, another unique precursor sequence has been identified in the distal fallopian tube, an indirect benefit from pathologic protocols that target the fimbria (SEE-FIM) for careful examination. Such studies have revealed the fimbria to be a starting point for high-grade serous carcinomas. By anchoring the origin of a high percentage of these tumors in the fimbria rather than ovary, investigators can now explore the exceptions to this new ‘rule’ and whether a dualistic model of high-grade serous cancer exists. These endeavors have placed the pathologist at the heart of cervical and ovarian cancer prevention.
Keynote Lecture: KN08 Keynote Lecture: KN06 UPDATE ON THE WHO CLASSIFICATION OF MALIGNANT LYMPHOMAS Steven H. Swerdlow University of Pittsburgh School of Medicine, Pittsburgh, PA, USA With the current 2008 WHO monograph on the classification of malignant lymphomas about 6 years old, work on a significant update has begun. A meeting of the Clinical Advisory Committee was already held, where the editors, selected authors and
ENHANCING PATHOLOGY EDUCATION AND PRACTICES IN COUNTRIES-IN-NEED: A CALL FOR ACTION Lai-Meng Looi1,2 1Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, and 2World Association of Societies of Pathology and Laboratory Medicine Although 20th century reforms in medical education and healthcare have led to an impressive doubling of human life-span, there
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
Pathology (2014), 46(S2)
PATHOLOGY 2014 ABSTRACT SUPPLEMENT
Since Siegfried Oberndorfer used the term carcinoid in 1907, this type of tumor has disclosed hormonally-active function and early metastases to the liver and lymph nodes. Neuroendocrine tumors (NETs) are now better accepted to represent the tumors. Thus, the WHO classification in 2000 first used the term endocrine tumors (ETs) instead of carcinoid, and NETs have been accepted as more popular terminology, i.e., well differentiated NET, well differentiated NEC (carcinoma) and poorly differentiated NEC. In the 2010 WHO classification of the digestive tract, NETs were re-classified to NET Grade (G)1, NET G2 and NEC, according to mitotic counts or Ki-67 labeling index. Neuroendocrine carcinoma, Ki-67 index higher than 20%, is composed of small and large cell types. Genetic background has been pointed out in pancreatic NETs such as mutations of MEN1, VHL and NF1 with specific biologic features. For therapeutic aspect, the expression of somatostatin receptor (SSTR2) is frequent (approximately 60%) in gastroenteric-pancreatic (GEP) NET and NEC, suggesting the response to somatostatin analogues, an example of molecular targeted therapy. Among NEC, a recently proposed category of NET G3 with typical neuroendocrine histological pattern and higher SSTR2 expression will be discussed. This lecture will highlight the important role of pathologists in diagnosis and therapy for NET and NEC.
Key Note Lecture: KN05 THE UPDATED GLEASON GRADING SYSTEM: MAKING IT RELEVANT TO CONTEMPORARY PRACTICE Jonathan I. Epstein Department of Pathology, The Johns Hopkins Medical Institutions, USA The talk will briefly cover why there was a need for modifying the original Gleason grading system. Multiple images will be presented covering the variations of different Gleason grade patterns and certain pitfalls in grading. Grading of variants of prostate cancer, such as foamy gland cancer, pseudohyperplastic cancer, ductal adenocarcinoma, cancer with vacuoles, mucinous carcinomas, and small cell carcinoma will be presented. The grading of cancer with mucinous fibroplasia as Gleason pattern 3 in most cases and cancer with glomeruloid features as Gleason pattern 4 will be discussed. Issues relating to grading needle biopsy when there is either a lower grade or higher present to a limited extent will be covered, as will the topic of tertiary grade patterns on needle biopsy and radical prostatectomy. Finally, the presentation will end with a brief review of prognostic information relating to the different Gleason grade patterns including a new Prognostic Grade Grouping.
internationally prominent clinicians held wide-ranging discussions concentrating on areas where new validated data exists that would impact on the classification or on the characterization and criteria for specific entities. Although publication of the update is not expected until Fall, 2015, areas in need of updating are established. On the B-cell side, there is great interest in dealing with the borders of lymphoma and clonal proliferations that are not overtly malignant as well as in learning how to best deal with the extra-aggressive B-cell lymphomas. New molecular discoveries have also had a major impact such as BRAF V600E mutations in hairy cell leukemia and MYD88 L265P mutation in lymphoplasmacytic lymphomas. We are also learning more about the complexity of the mature T-cell lymphomas and how to deal with the spectrum of T-cell lymphomas derived from T follicular helper cells and gamma delta type T-cells. Indolent clonal T- and NK-cell proliferations, such as those in the GI tract, have also received increased attention.
Keynote Lecture: KN07 ORIGINS OF CANCER: FROM THE CERVIX TO THE FALLOPIAN TUBE Christopher P. Crum Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA Success in cancer prevention depends on our understanding of its origins. In the past several years, we have gained insights into the pathogenesis of both cervical and ovarian cancer. We have identified a unique cell at the cervical squamo-columnar junction that has been proposed as a potential origin for most cervical cancers. This new information has put cervical precursors into perspective and explained the diversity of phenotypes associated with high-risk HPV infections. Moreover, it has raised the intriguing possibility that the squamo-columnar junction could be targeted in a cervical cancer prevention strategy for women who would not gain the maximum benefit from vaccination. In the upper genital tract, another unique precursor sequence has been identified in the distal fallopian tube, an indirect benefit from pathologic protocols that target the fimbria (SEE-FIM) for careful examination. Such studies have revealed the fimbria to be a starting point for high-grade serous carcinomas. By anchoring the origin of a high percentage of these tumors in the fimbria rather than ovary, investigators can now explore the exceptions to this new ‘rule’ and whether a dualistic model of high-grade serous cancer exists. These endeavors have placed the pathologist at the heart of cervical and ovarian cancer prevention.
Keynote Lecture: KN08 Keynote Lecture: KN06 UPDATE ON THE WHO CLASSIFICATION OF MALIGNANT LYMPHOMAS Steven H. Swerdlow University of Pittsburgh School of Medicine, Pittsburgh, PA, USA With the current 2008 WHO monograph on the classification of malignant lymphomas about 6 years old, work on a significant update has begun. A meeting of the Clinical Advisory Committee was already held, where the editors, selected authors and
ENHANCING PATHOLOGY EDUCATION AND PRACTICES IN COUNTRIES-IN-NEED: A CALL FOR ACTION Lai-Meng Looi1,2 1Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia, and 2World Association of Societies of Pathology and Laboratory Medicine Although 20th century reforms in medical education and healthcare have led to an impressive doubling of human life-span, there
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.